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Arturo Fierros-Hernández, Alejandro Ayala-Zúñiga
Este artículo busca aclarar el panorama epidémico que se generó en Baja California a finales del siglo XIX y principios del XX, específicamente el que se dio en 1883 y 1902, años en los que se afirma que ocurrieron epidemias de fiebre amarilla y peste bubónica, respectivamente. Sin embargo, como se demuestra en nuestro estudio, nunca ocurrieron debido a las condiciones sociodemográficas de la zona.
2018: Gaceta Médica de México
Ghobad Azizi, James M Keller, Michelle L Mayo, Kelé Piper, David Puett, Karly M Earp, Carl D Malchoff
PURPOSE: To compare shear wave elastography (SWE) and Afirma™ gene expression classifier (GEC) for diagnosis of malignancy in thyroid nodules (TNs) with Bethesda Classification (BC) III or IV indeterminate cytology. METHODS: This preliminary single-center prospective study was approved by the Institutional Review Board. We evaluated 151 consented patients with 151 indeterminate TNs (123 BC III, 28 BC IV) on fine-needle aspiration biopsy (FNAB). B-mode ultrasound, vascularity, and SWE were performed prior to FNAB...
January 19, 2018: Endocrine
Michiya Nishino, Marina Nikiforova
CONTEXT: - Approximately 15% to 30% of thyroid nodules that undergo fine-needle aspiration are classified as cytologically indeterminate, presenting management challenges for patients and clinicians alike. During the past several years, several molecular tests have been developed to reduce the diagnostic uncertainty of indeterminate thyroid fine-needle aspirations. OBJECTIVE: - To review the methodology, clinical validation, and recent peer-reviewed literature for 4 molecular tests that are currently marketed for cytologically indeterminate thyroid fine-needle aspiration specimens: Afirma, ThyroSeq, ThyGenX/ThyraMIR, and RosettaGX Reveal...
January 16, 2018: Archives of Pathology & Laboratory Medicine
Elizabeth J de Koster, Lioe-Fee de Geus-Oei, Olaf M Dekkers, Ilse van Engen-van Grunsven, Jaap Hamming, Eleonora P M Corssmit, Hans Morreau, Abbey Schepers, Jan Smit, Wim J G Oyen, Dennis Vriens
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As approximately 25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a pre-operative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques...
January 2, 2018: Endocrine Reviews
D N Poller, S Glaysher
This review summarises molecular pathological techniques applicable to thyroid FNA. The molecular pathology of thyroid tumours is now fairly well understood. Molecular methods may be used as a rule-in test for diagnosis of malignancy in thyroid nodules, eg BRAF V600E point mutation, use of a seven-gene mutational panel (BRAF V600E, RAS genes, RET/PTC or PAX8/PPARG rearrangement), or as a comprehensive multigene next-generation sequencing panel, eg ThyroSeq v2. Molecular methods can also be applied as rule-out tests for malignancy in thyroid nodules, eg Afirma or ThyroSeq v2 or as markers of prognosis, eg TERT promoter mutation or other gene mutations including BRAF V600E, TP53 and AKT1, and as tests for newly defined tumour entities such as non-invasive follicular thyroid neoplasm with papillary like nuclei, or as a molecular marker(s) for targeted therapies...
December 2017: Cytopathology: Official Journal of the British Society for Clinical Cytology
Courtney J Balentine, David J Vanness, David F Schneider
BACKGROUND: We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. METHODS: We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature...
January 2018: Surgery
Kristina J Nicholson, Linwah Yip
PURPOSE OF REVIEW: Correct identification of malignancy in cytologically indeterminate thyroid nodules is a diagnostic challenge, leading to potentially unnecessary surgery in patients for whom final histology is benign. Similarly, many patients with differentiated thyroid cancer (DTC) undergo aggressive surgical management of tumors, which may ultimately have low-risk histologic features. Use of molecular testing strategies can aid in both the diagnosis of indeterminate thyroid nodules and preoperative risk stratification of DTC...
January 2018: Current Opinion in Oncology
Quan-Yang Duh, Naifa L Busaidy, Catherine Rahilly-Tierney, Hossein Gharib, Gregory Randolph
BACKGROUND: The Afirma(®) Gene Expression Classifier (GEC) risk stratifies The Bethesda System for the Reporting of Thyroid Cytopathology class III/IV (indeterminate) thyroid nodules (ITNs) as suspicious for malignancy or benign. Several authors have published studies describing the diagnostic accuracy of the GEC. However, the quality of these methods has not been rigorously examined. SUMMARY: In this study, MEDLINE and EMBASE were searched for studies published between January 1, 2010, and June 30, 2016, examining the sensitivity, specificity, negative predictive value, and positive predictive value of the GEC...
October 2017: Thyroid: Official Journal of the American Thyroid Association
Simon Sung, Anjali Saqi, Elizabeth M Margolskee, John P Crapanzano
BACKGROUND: Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%-30% risk of malignancy and are often followed up with surgical resection...
2017: CytoJournal
Jen-Fan Hang, William H Westra, David S Cooper, Syed Z Ali
BACKGROUND: A recent revision in thyroid tumor nomenclature has resulted in a change from a malignant diagnosis (noninvasive follicular variant of papillary thyroid carcinoma) to one that is nonmalignant (noninvasive follicular thyroid neoplasm with papillary-like nuclear features [NIFTP]). The objective of the current study was to evaluate the impact of this change on the performance of the Afirma gene expression classifier (GEC). METHODS: The authors retrospectively analyzed consecutive thyroid fine-needle aspiration specimens with indeterminate diagnoses on which GEC was performed...
September 2017: Cancer
Grant Harrison, Julie Ann Sosa, Xiaoyin Jiang
CONTEXT: - Molecular testing in indeterminate thyroid nodules is a rapidly evolving field with variable reported outcomes. OBJECTIVE: - To report our experience at a tertiary thyroid referral center with the Afirma Gene Expression Classifier (Veracyte, San Francisco, California) in repeat fine-needle aspirations of thyroid nodules with a previous indeterminate cytologic result. DESIGN: - Results of cytopathology and the Afirma test were collected from August 2013 to March 2015, as were diagnoses from surgical resection when performed...
July 2017: Archives of Pathology & Laboratory Medicine
Emily Kay-Rivest, Jamie Tibbo, Sarah Bouhabel, Michael Tamilia, Rebecca Leboeuf, Veronique-Isabelle Forest, Michael P Hier, Loren Savoury, Richard J Payne
BACKGROUND: Thyroid nodules are common and often benign, although prove to be malignant upon surgical pathology in 5-15% of cases. When assessed with ultrasound-guided fine-needle aspiration (USFNA), 15-30% of the nodules yield an indeterminate result. The Afirma® gene expression classifier (AGEC) was developed to improve management of indeterminate thyroid nodules (ITNs) by classifying them as "benign" or "suspicious." Objectives were (1) to assess the performance of the AGEC in two Canadian academic medical centres (2), to search for inter-institutional variation and (3) to compare AGEC performance in Canadian versus American institutions...
April 4, 2017: Journal of Otolaryngology—Head & Neck Surgery
Robert P Domingo, Lorna L Ogden, Laura C Been, Giulia C Kennedy, S Thomas Traweek
OBJECTIVES: Parathyroid (PT) lesions can be difficult to recognize in thyroid fine needle aspirations (FNAs), and when not identified correctly, PT cells may be mistaken for potentially abnormal thyroid cells. We therefore studied the utility of combining cytology, immunohistochemistry, and a molecular classifier to identify PT cells in thyroid FNAs. METHODS: Thyroid FNAs were received in CytoLyt, and were evaluated initially using The Bethesda System for Reporting Thyroid Cytology (TBSRTC)...
June 2017: Diagnostic Cytopathology
Sudarshana Roychoudhury, Melissa Klein, Fabiola Souza, Cecilia Gimenez, Alice Laser, Rubina Shaheen Cocker, Karen Chau, Kasturi Das
BACKGROUND: The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. METHODS: The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015...
April 2017: Diagnostic Cytopathology
Sylvan C Baca, Kristine S Wong, Kyle C Strickland, Howard T Heller, Matthew I Kim, Justine A Barletta, Edmund S Cibas, Jeffrey F Krane, Ellen Marqusee, Trevor E Angell
BACKGROUND: Thyroid nodules with atypia of undetermined significance (AUS) on fine-needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve preoperative risk stratification of thyroid nodules, but its performance for different patterns of AUS has not been defined. The objective of this study was to assess GEC results and clinical outcomes in AUS nodules with architectural atypia (AUS-A), cytologic atypia (AUS-C) or both (AUS-C/A)...
May 2017: Cancer Cytopathology
Daniela Pirela, Daniela Treitl, Siba El Hussein, Robert Poppiti, Thomas Mesko, Alex Manzano
Water-clear cell adenoma (WCCA) of the parathyroid gland is an exceedingly rare neoplasm. To date, 17 cases have been reported in the literature, with only one of them being intrathyroidal. Here we report a case of a 34-year-old woman who presented for evaluation of a goiter and was found to have a thyroid nodule and abnormal thyroid function tests (TFT). Fine needle aspiration biopsy of the nodule revealed thyroid follicular cells without atypia and subsequent Afirma® Gene Expression Classifier (GEC) testing results were suspicious for malignancy...
2016: Case Reports in Pathology
Xiaoyin Sara Jiang, Grant P Harrison, Michael B Datto
BACKGROUND: Molecular testing provides an important ancillary study for thyroid nodules with indeterminate cytology. The nomenclature shift to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) will impact the performance of molecular tests. For the current study, the authors reviewed the performance of the Afirma gene-expression classifier (GEC) and the University of Pittsburgh Medical Center (UPMC) targeted mutation panel tests in thyroid nodules that were subsequently diagnosed as NIFTP on surgical resection...
December 2016: Cancer
Ming Zhang, Oscar Lin
CONTEXT: - Fine-needle aspiration of thyroid nodules is a reliable diagnostic method to determine the nature of thyroid nodules. Nonetheless, indeterminate cytology diagnoses remain a diagnostic challenge. The development of multiplex molecular techniques and the identification of genetic alterations associated with different follicular cell-derived cancers in the thyroid have led to the introduction of several commercially available tests. OBJECTIVE: - To summarize the most common commercially available molecular testing in thyroid cancer, focusing on the technical features and test performance validation...
December 2016: Archives of Pathology & Laboratory Medicine
T Danielle Samulski, Virginia A LiVolsi, Lawrence Q Wong, Zubair Baloch
BACKGROUND: The gene expression classifier (GEC; Afirma-Veracyte) has proven to be an effective triage modality in the management of thyroid nodules. We evaluate our institutional experience with GEC, specifically examining performance as a first line testing strategy versus in conjunction with repeat fine needle aspiration (FNA), usage trends based on clinical setting, and performance related to diagnostic categories of The Bethesda System for Reporting Thyroid Cytology (TBSRTC). METHODS: All nodules undergoing GEC analysis from 1/2011 to 12/2015 at the Hospital of the University of Pennsylvania were identified using electronic database search methods...
November 2016: Diagnostic Cytopathology
Carmen V Villabona, Vineeth Mohan, Karla M Arce, Julia Diacovo, Alisha Aggarwal, Jessica Betancourt, Hassan Amer, Tessey Jose, Pascual DeSantis, Jose Cabral
OBJECTIVE: Thyroid nodules with fine-needle aspiration (FNA) cytology categorized as atypia of undetermined significance (AUS) often undergo additional diagnostic analysis with the Afirma Gene Expression Classifier (GEC), which classifies these as either high probability of being benign (GEC-B) or suspicious for malignancy (GEC-S). Our goal was to assess the clinical validity and utility of GEC in the evaluation of AUS cytology and evaluate the performance of ultrasonography (USG) for predicting malignancy in this subset...
October 2016: Endocrine Practice
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